Cited by 192Sleep and related disordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesObstructive Sleep Apnea Research

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The evidence base of sleep restriction therapy for treating insomnia disorder

Miller, Christopher B., Espie, Colin A., Epstein, Dana R., Friedman, Leah, Morin, Charles M., Pigeon, Wilfred R., Spielman, Arthur J., Kyle, Simon D.·2014·Sleep Medicine Reviews

DOI 10.1016/j.smrv.2014.01.006

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Abstract

Sleep restriction therapy is routinely used within cognitive behavioral therapy to treat chronic insomnia. However, the efficacy for sleep restriction therapy as a standalone intervention has yet to be comprehensively reviewed. This review evaluates the evidence for the use of sleep restriction therapy in the treatment of chronic insomnia. The literature was searched using web-based databases, finding 1344 studies. Twenty-one were accessed in full (1323 were deemed irrelevant to this review). Nine were considered relevant and evaluated in relation to study design using a standardized study checklist and levels of evidence. Four trials met adequate methodological strength to examine the efficacy of therapy for chronic insomnia. Weighted effect sizes for self-reported sleep diary measures of sleep onset latency, wake time after sleep onset, and sleep efficiency were moderate-to-large after therapy. Total sleep time indicated a small improvement. Standalone sleep restriction therapy is efficacious for the treatment of chronic insomnia for sleep diary continuity variables. Studies are insufficient to evaluate the full impact on objective sleep variables. Measures of daytime functioning in response to therapy are lacking. Variability in the sleep restriction therapy implementation methods precludes any strong conclusions regarding the true impact of therapy. A future research agenda is outlined.

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“This technique matches the presenting caregivers’ time spent in bed to their current sleep ability, and is effective as both a stand-alone and component of treatment (Harvey et al., 2002; Miller et al., 2014).”
The Effectiveness of Digital Insomnia Treatment with Adjunctive Wearable Technology: A Pilot Randomized Controlled Trial
Aji, M., Glozier, N., Bartlett, D. J., Grunstein, R. R., Calvo, R. A., Marshall, N. S., White, D. P., & Gordon, C. J. (2021) · Behavioral Sleep Medicine · doi:10.1080/15402002.2021.1967157 · Cited by 24
“Inclusion criteria were aged 18 years to 65 years, literate in English, score of ≥ 15 on the Insomnia Severity Index (ISI) (Bastien et al., 2001; Morin et al., 2011), and a global score of >5 on the Pittsburgh sleep quality index (PSQI) (Buysse et al., 1989).”
BackgroundMethod
Novel Treatment Based on Acceptance and Commitment Therapy Versus Cognitive Behavioral Therapy for Insomnia: A Randomized Comparative Effectiveness Trial in Women Veterans
Martin, J. L., Carlson, G. C., Kelly, M. R., Song, Y., Mitchell, M. N., Josephson, K. R., McGowan, S. K., Culver, N. C., Kay, M. A., Erickson, A. J., et al. (2023) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000836 · Cited by 23
A Drosophila model of sleep restriction therapy for insomnia
Belfer, S. J., Bashaw, A. G., Perlis, M. L., & Kayser, M. S. (2019) · Molecular Psychiatry · doi:10.1038/s41380-019-0376-6 · Cited by 25
A feasibility study of a mobile app to treat insomnia
Aji, M., Glozier, N., Bartlett, D. J., Peters, D., Calvo, R. A., Zheng, Y., Grunstein, R. R., & Gordon, C. J. (2020) · Translational Behavioral Medicine · doi:10.1093/tbm/ibaa019 · Cited by 22
An Actigraphy-Based Validation Study of the Sleep Disorder Inventory in the Nursing Home
Hjetland, G. J., Nordhus, I. H., Pallesen, S., Cummings, J. L., Tractenberg, R. E., Thun, E., Kolberg, E., & Flo, E. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00173 · Cited by 25
“(25) defined disturbed sleep as having <85% SE, in each participants’ individual rest interval (based on light, activity, and event marker information in the actogram, indicating bedtime and wake time), which is a common cut-off for defining disturbed sleep (55, 56), albeit in normal populations.”
Background
Evidenced-Based Review and Evaluation of Clinical Significance: Nonpharmacological and Pharmacological Treatment of Insomnia in the Elderly
Flaxer, J. M., Heyer, A., & Francois, D. (2020) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2020.10.011 · Cited by 22
Comparing the Effects of Single‐ and Multiple‐Component Therapies for Insomnia on Sleep Outcomes
Sidani, S., Epstein, D. R., Fox, M. T., & Collins, L. J. (2019) · Worldviews on Evidence-Based Nursing · doi:10.1111/wvn.12367 · Cited by 25
“These results support the effectiveness of SRT as a single component therapy, as also documented by Miller et al. (2014).”
ResultSelf-citation
Impact of chronic sleep restriction on sleep continuity, sleep structure, and neurobehavioral performance
Xin, Q., Yuan, R. K., Zitting, K., Wang, W., Purcell, S., Vujović, N., Ronda, J. M., Quan, S. F., Williams, J. S., Buxton, O. M., et al. (2022) · SLEEP · doi:10.1093/sleep/zsac046 · Cited by 22
Follow-Up Analyses From a Wait-List Controlled Trial of Occupational Therapist–Delivered Cognitive–Behavioral Therapy for Insomnia Among Veterans With Chronic Insomnia
Eakman, A. M., Schmid, A. A., Rolle, N. R., Kinney, A. R., & Henry, K. L. (2022) · American Journal of Occupational Therapy · doi:10.5014/ajot.2022.045682 · Cited by 21
“I for the treatment of chronic insomnia (Miller et al., 2014; van der Zweerde et al., 2019; van Straten et al., 2018).”
Psychological Interventions for Late-Life Insomnia: Current and Emerging Science
Dzierzewski, J. M., Griffin, S. C., Ravyts, S. G., & Rybarczyk, B. D. (2018) · Current Sleep Medicine Reports · doi:10.1007/s40675-018-0129-0 · Cited by 20
Paradoxical intention for insomnia: A systematic review and meta‐analysis
Jansson‐Fröjmark, M., Alfonsson, S., Bohman, B., Rozental, A., & Norell‐Clarke, A. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13464 · Cited by 18
“The items are consistent with the recommendations of the Centre for Reviews and Dissemination for systematic reviews (Akers et al., 2009) and with previous study assessment approaches in the area of insomnia disorder (Miller et al., 2014; Morin et al., 2006).”
BackgroundMethod
Dysfunctional beliefs and attitudes about sleep (DBAS) mediate outcomes in dCBT-I on psychological distress, fatigue, and insomnia severity
Faaland, P. M., Vedaa, Ø., Langsrud, K., Sivertsen, B., Lydersen, S., Saksvik, S. B., Vestergaard, C. L., Kjørstad, K., Vethe, D., Ritterband, L. M., et al. (2023) · Sleep Medicine · doi:10.1016/j.sleep.2023.07.018 · Cited by 19
Implementing the Integrated Strategy for the Cultural Adaptation of Evidence-Based Interventions: An Illustration
Sidani, S., Ibrahim, S., Lok, J., Fan, L., & Fox, M. T. (2018) · Canadian Journal of Nursing Research · doi:10.1177/0844562118774493 · Cited by 18
The effectiveness of stimulus control in cognitive behavioural therapy for insomnia in adults: A systematic review and network meta‐analysis
Verreault, M. D., Granger, É., Neveu, X., Delage, J. P., Bastien, C., & Vallières, A. (2023) · Journal of Sleep Research · doi:10.1111/jsr.14008 · Cited by 22
“Among the main components of CBT-I, a few studies evaluated SRT and cognitive therapy effectiveness when used alone, or their mechanisms of action (Harvey et al., 2014; Kyle et al., 2015; Maurer & Kyle, 2022; Miller et al., 2014; Riemann et al., 2022; Spielman et al., 1987; Vallières et al., 2013).”
Background
The Effects of Objective Push-Type Sleep Feedback on Habitual Sleep Behavior and Momentary Symptoms in Daily Life: mHealth Intervention Trial Using a Health Care Internet of Things System
Takeuchi, H., Suwa, K., Kishi, A., Nakamura, T., Yoshiuchi, K., & Yamamoto, Y. (2022) · JMIR mhealth and uhealth · doi:10.2196/39150 · Cited by 18
“In the treatment of patients with insomnia, sleep restriction therapy, which induces mild sleep deprivation to build homeostatic sleep pressure, is used, and existing mHealth studies incorporating sleep restriction therapy demonstrate a significant improvement in insomnia severity and sleep efficacy [35,64,65].”
Background
Daytime sleepiness, driving performance, reaction time and inhibitory control during sleep restriction therapy for Chronic Insomnia Disorder
Whittall, H., Pillion, M., & Gradisar, M. (2017) · Sleep Medicine · doi:10.1016/j.sleep.2017.10.007 · Cited by 16
Effects of Educational Counseling as Solitary Therapy for Chronic Primary Tinnitus and Related Problems
Liu, Y., Chen, Z., Li, G., Lai, D., Liu, P., & Zheng, Y. (2018) · BioMed Research International · doi:10.1155/2018/6032525 · Cited by 19
“Subjective sleep quality, indicated by sleep onset latency, awakening time after sleep onset, and sleep efficiency, improved after sleep restriction, and the effect size was moderate to large [39].”
Background
The Impact of Cognitive Behavioral Therapy for Insomnia on Sleep Log and Actigraphy Outcomes in People with Multiple Sclerosis: A Secondary Analysis
Williams-Cooke, C., LeSuer, L., Drerup, M. L., & Siengsukon, C. F. (2021) · Nature and Science of Sleep · doi:10.2147/nss.s324879 · Cited by 16
Intraindividual variability in sleep schedule: effects of an internet-based cognitive-behavioral therapy for insomnia program and its relation with symptom remission
Shaffer, K. M., Hedeker, D., Morin, C. M., Ingersoll, K. S., Thorndike, F. P., & Ritterband, L. M. (2020) · SLEEP · doi:10.1093/sleep/zsaa115 · Cited by 15
Self-citation
Opening the curtains for better sleep in psychotic disorders - considerations for improving sleep treatment
Barrett, E. A., Aminoff, S. R., Simonsen, C., & Romm, K. L. (2020) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2020.152207 · Cited by 15
Treatment feasibility of a digital tool for brief self‐help behavioural therapy for insomnia ( FastAsleep )
Jernelöv, S., Forsell, E., Westman, H., Dufva, Y. E., Lindefors, N., Kaldo, V., & Kraepelien, M. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13759 · Cited by 16
“Several studies suggest that sleep restriction and stimulus control are core therapeutic methods in CBT-i, and even effective as standalone interventions (Bootzin & Epstein, 2011; Edinger et al., 2021; Harvey et al., 2002; Kaldo et al., 2015; Miller et al., 2014; Morin, 2011; Morin et al., 1994, 2006, 2015), and they…”
Background
Patients’ experiences of motivation, change, and challenges in group treatment for insomnia in primary care: a focus group study
Sandlund, C., Kane, K., Ekstedt, M., & Westman, J. (2018) · BMC Family Practice · doi:10.1186/s12875-018-0798-2 · Cited by 18
“However, one study has explored patients’ experiences of long-term treatment with hypnotic drugs [15]; another, patients’ experiences of mindfulness-based group treatment for insomnia [16]; and a third, patients’ experiences of sleep restriction therapy, one technique included in CBT-I [17].”
MethodInfluential
The effect of single‐component sleep restriction therapy on depressive symptoms: A systematic review and meta‐analysis
Tse, K. Y. K., Maurer, L. F., Espie, C. A., & Kyle, S. D. (2024) · Journal of Sleep Research · doi:10.1111/jsr.14180 · Cited by 12
Self-citation
Risk of excessive sleepiness in sleep restriction therapy and cognitive behavioral therapy for insomnia: a randomized controlled trial
Cheng, P., Kalmbach, D. A., Fellman-Couture, C., Arnedt, J. T., Cuamatzi-Castelan, A. S., & Drake, C. L. (2020) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.8164 · Cited by 14
“Restriction of time in bed (TIB) with the aim of consolidating sleep (ie, sleep restriction) is a core component of cognitive behavioral therapy for insomnia (CBT-I), and has efficacy as a single-component therapy.(1) As a stand-alone treatment, sleep restriction therapy (SRT) putatively leverages the homeostatic slee…”
BackgroundMethod
The Integration of Sleep Research Into Eating Disorders Research: Recommendations and Best Practices
Irish, L. A., Bottera, A. R., Manasse, S. M., Christensen, K. A., & Schaefer, L. M. (2024) · International Journal of Eating Disorders · doi:10.1002/eat.24241 · Cited by 14
Cognitive and behavioural therapy for insomnia in the treatment of adolescent insomnia: A systematic review and meta‐analysis of randomised controlled trials
Galgut, Y., Hoyos, C. M., Kempler, L., Aji, M., Grunstein, R. R., Gordon, C. J., & Bartlett, D. J. (2024) · Journal of Sleep Research · doi:10.1111/jsr.14442 · Cited by 14
“In adults, SRT is an effective standalone treatment for insomnia with post-treatment effect sizes noted as large as multicomponent CBTi when compared with a con-trol group (Maurer et al., 2021; Miller et al., 2014).”
Treating insomnia in Swiss primary care practices: A survey study based on case vignettes
Linder, S., Duss, S. B., Dvořák, C., Merlo, C., Essig, S., Tal, K., Giovane, C. D., Syrogiannouli, L., Heinzer, R. C., Nissen, C., et al. (2020) · Journal of Sleep Research · doi:10.1111/jsr.13169 · Cited by 13
“Sleep restriction has been found effective also when used alone (Krieger et al., 2019; Miller et al., 2014).”
Background
The translational genetics of ADHD and related phenotypes in model organisms
Cabana‐Domínguez, J., Antón-Galindo, E., Fernàndez‐Castillo, N., Singgih, E. L., O’Leary, A., Norton, W., Strekalova, T. V., Schenck, A., Reif, A., Lesch, K., et al. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104949 · Cited by 15
“Sleep restriction therapy (SRT) is widely used as a part of cognitive behavior therapy for insomnia (CBT-I) and performing SRT alone is sufficient to confer most CBT-I benefits (Miller et al., 2014).”
Background
Healthy Nutrition, Physical Activity, and Sleep Hygiene to Promote Cardiometabolic Health of Airline Pilots: A Narrative Review
Wilson, D., Driller, M. W., Johnston, B., & Gill, N. (2023) · Journal of Lifestyle Medicine · doi:10.15280/jlm.2023.13.1.1 · Cited by 19
“Sleep restriction therapy has demonstrated moderate-to-large effect sizes for reducing night waking and enhancing sleep latency and efficiency, however the impact on daytime sleepiness is inconclusive and this strategy may not be appropriate for airline pilots due to regular changes in rosters [82].”
Background
Cognitive Behavioral Therapy for Insomnia: A Promising Treatment for Insomnia, Pain, and Depression in Patients With IBD
Salwen‐Deremer, J. K., Siegel, C. A., & Smith, M. T. (2020) · Crohn s & Colitis 360 · doi:10.1093/crocol/otaa052 · Cited by 16
Trialling a microbiome-targeted dietary intervention in children with ADHD—the rationale and a non-randomised feasibility study
Lawrence, K., Myrissa, K., Toribio-Mateas, M. A., Minini, L., & Gregory, A. M. (2022) · Pilot and Feasibility Studies · doi:10.1186/s40814-022-01058-4 · Cited by 13
“The actigraphy measures of sleep showed a consistent pattern for small improvements in sleep quality, with a reduction in total sleep duration; by improving sleep quality it can be consolidated [109].”
Background
The comparison of brief, online mindfulness and relaxation interventions to reduce stress and improve sleep-related outcomes in college students
Pickett, S. M., Kozak, A. T., Lanni, D. J., Warnke, A. S., Gaillard, P., & Jarrett, N. L. (2022) · Journal of American College Health · doi:10.1080/07448481.2022.2066979 · Cited by 15
Personalised app-based relapse prevention of depressive and anxiety disorders in remitted adolescents and young adults: a protocol of the StayFine RCT
Robberegt, S. J., Kooiman, B., Albers, C. J., Nauta, M. H., Bockting, C., & Stikkelbroek, Y. A. J. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-058560 · Cited by 13
Primary care treatment of insomnia: study protocol for a pragmatic, multicentre, randomised controlled trial comparing nurse-delivered sleep restriction therapy to sleep hygiene (the HABIT trial)
Kyle, S. D., Madigan, C. D., Begum, N., Abel, L., Armstrong, S., Aveyard, P. N., Bower, P., Ogburn, E., Siriwardena, A. N., Yu, L., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-036248 · Cited by 12
Self-citation
Sleep and Cognition in People with Autism Spectrum Condition: A Systematic Literature Review
Shaw, A., Do, T., Harrison, L. K., Marczak, M., Dimitriou, D., & Joyce, A. (2021) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-021-00266-7
A Comprehensive Review of Lemborexant to Treat Insomnia
Fuller, M. C., Carlson, S. F., Grant, C., Berry, V., Ivancich, M. S., Cornett, E. M., Kaye, A. M., Viswanath, O., Urits, I., Shekoohi, S., et al. (2025) · Psychopharmacology Bulletin · doi:10.64719/pb.4483 · Cited by 11
Treating comorbid insomnia in patients enrolled in therapist-assisted transdiagnostic internet-delivered cognitive behaviour therapy for anxiety and depression: A randomized controlled trial
Edmonds, M., Peynenburg, V. A., Kaldo, V., Jernelöv, S., Titov, N., Dear, B. F., & Hadjistavropoulos, H. D. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100729 · Cited by 10
“The goal of sleep restriction is to increase sleep efficiency by creating a new “ sleep window ” (i.e., amount of time spent in bed) and then gradually titrating the amount of time in bed contingent upon increased sleep efficiency (Miller et al., 2014).”
Background
A randomised controlled dismantling trial of sleep restriction therapies for chronic insomnia disorder in middle childhood: effects on sleep and anxiety, and possible contraindications
Cain, N., Richardson, C. E., Bartel, K., Whittall, H., Reeks, J., & Gradisar, M. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13658 · Cited by 11
“Due to the lack of evidence informing sleep restriction therapies in children, for both sleep and bedtime restriction therapy there was no lower limit of restriction specified (some adult protocols specify no <5 h TIB) (Miller et al., 2014).”
Background

Authors: Miller, C. B., Espie, C. A., Epstein, D. R., Friedman, L., Morin, C. M., Pigeon, W. R., Spielman, A. J., & Kyle, S. D.
Affiliations: The University of Sydney (AU)
University of Oxford (GB)
Phoenix VA Health Care System (US)
VA Palo Alto Health Care System (US)
Université Laval (CA)
United States Department of Veterans Affairs (US)
City College of New York (US)
University of Manchester (GB)
Corresponding author: Miller, Christopher B.
ORCID: Miller, Christopher B.
Espie, Colin A.
Epstein, Dana R.
Morin, Charles M.
Pigeon, Wilfred R.
Kyle, Simon D.
Venue: Sleep Medicine Reviews
Publisher: Elsevier BV
Published: 2014-10
Volume: 18
Issue: 5
Pages: 415-424
ISSN: 1087-0792 (ISSN-L)
DOI: 10.1016/j.smrv.2014.01.006
OpenAlex: W2165118243
Cited by: 192
References: 80
Citations by year: 2026: 11 · 2025: 10 · 2024: 10 · 2023: 22 · 2022: 27 · 2021: 24 · 2020: 21 · 2019: 14 · 2018: 17 · 2017: 13 · 2016: 10 · 2015: 9 · 2014: 3
FWCI: 1.58
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Sleep Medicine Reviews (publishedVersion)
PubMed (publishedVersion)
Research Explorer (The University of Manchester) (publishedVersion)
Funders: National Health and Medical Research Council (NHMRC, Australia) Centre for Integrated Research and Understanding of Sleep (CIRUS) (571421)
Sackler Institute of Psychobiological Research (University of Glasgow Sleep Centre, Scotland, UK)
Chief Scientist Office (Scotland, UK) (CZG/2/503)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
Keywords: sleep restriction therapy, chronic insomnia, insomnia, sleep diary, sleep latency, wake after sleep onset, sleep efficiency, total sleep time, treatment efficacy, cognitive behavioral therapy
MeSH terms: Humans, Sleep Initiation and Maintenance Disorders, Sleep Deprivation, Cognitive Behavioral Therapy, Treatment Outcome

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The evidence base of sleep restriction therapy for treating insomnia disorder

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